Laius Ott, Pisarev Heti, Maasalu Katre, Kõks Sulev, Märtson Aare
Department of Traumatology and Orthopedics, University of Tartu, Institute of Clinical Medicine, L.Puusepa 8, Tartu, Estonia.
Estonian State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia.
Arch Osteoporos. 2017 Dec;12(1):59. doi: 10.1007/s11657-017-0354-z. Epub 2017 Jun 22.
Some patients do not take medicines as they are supposed to. Our research showed that in Estonia, one fifth of patients did not start treatment with osteoporosis medicines and only 20% used the medicines for at least 3 years as they should. This induces unnecessary costs to the healthcare system.
Medication non-adherence is the number one reason for not obtaining the expected clinical effect of medicines. With osteoporosis treatment, it has been shown that both implementation of treatment and persistence influence the risk of fractures significantly. Long-term adherence to medication in Estonia is to be determined with this study.
A 15-year retrospective study was carried out in order to establish initiation, implementation, and persistence of Estonian patients. All new users of osteoporosis medicines were analyzed for all prescriptions they received during the study period. Sufficient adherence to treatment was defined as a patient being dispensed 80% or more prescribed doses for at least 1 year.
The study period was from 2001 to 2015. Patients (24,652) were included in the study. Of the patients, 93.7% (n = 23,091) were women and 6.3% (n = 1564) were men. Eighteen percent (4636) were dispensed only one prescription. Of the patients, 44.2% included in the study had medication possession ratio (MPR) ≥80% over follow-up period; 8922 (36.2%) who were prescribed from 2001 to 2015 persisted for 1 year with MPR ≥80% and 19.8% persisted for 3 years. Forty percent of expenditure on osteoporosis medication was made for treatment courses with insufficient adherence.
There is room for improvement in Estonia with medication adherence relating to all three aspects that determine adherence-initiation, implementation, and persistence. This means further efforts are to be made to educate patients and healthcare professionals on realizing the importance of good adherence.
一些患者没有按医嘱服药。我们的研究表明，在爱沙尼亚，五分之一的患者没有开始使用骨质疏松症药物进行治疗，只有20%的患者按规定使用药物至少3年。这给医疗系统带来了不必要的成本。
用药依从性不佳是无法获得药物预期临床效果的首要原因。对于骨质疏松症治疗，已表明治疗的实施和持续性均会显著影响骨折风险。本研究旨在确定爱沙尼亚患者的长期用药依从性。
开展了一项为期15年的回顾性研究，以确定爱沙尼亚患者的用药起始、实施和持续性情况。对所有骨质疏松症药物的新使用者在研究期间收到的所有处方进行分析。充分的治疗依从性定义为患者在至少1年内获得80%或更多的规定剂量配药。
研究期间为2001年至2015年。共有24,652名患者纳入研究。其中，93.7%（n = 23,091）为女性，6.3%（n = 1564）为男性。18%（4636）的患者仅获得一张处方。在纳入研究的患者中，44.2%在随访期间的药物持有率（MPR）≥80%；2001年至2015年期间开具处方的患者中有8922名（36.2%）MPR≥80%持续了1年，19.8%持续了3年。骨质疏松症药物治疗费用的40%用于依从性不足的治疗疗程。
在爱沙尼亚，与决定依从性的三个方面——起始、实施和持续性相关的用药依从性方面仍有改进空间。这意味着要进一步努力教育患者和医疗专业人员认识到良好依从性的重要性。
